Clinical Applications

It is not known what proportion of receptors must be available or how sensitive a test must be to ensure adequate muscle strength to overcome airway obstruction and permit effective coughing and to be free of visual disturbances. The anesthesiologist should not rely on just one test of neuromuscular strength, but should use as many tests as practically possible ( Table 13-1 ). The results of Pavlin and colleagues^[53] and the relatively frequent admission of patients to the postanesthesia care unit (PACU) with unacceptable levels of neuromuscular blockade that was unrecognized by the anesthesiologist^{[58] [59] [60]} emphasize the difficulty in ensuring that no residual neuromuscular blockade exists after surgery and anesthesia.